Lung Torsion Research Articles

Predictors of survival in lung torsion: A systematic review and pooled analysis

ObjectiveLung torsion (LT) is a rare but life-threatening event. The objective of this study was to systematically review the natural history and clinical outcome of LT in published studies. MethodsA review of publications on LT from January 1950 to December 2014 was performed using 3 databases (PubMed, EMBASE, and Web of Science). The primary efficacy outcome was LT-related mortality. Intervention was classified as direct resection (resection without detorsion), indirect resection (resection after detorsion), and reposition. Univariate comparisons of survival were performed using a logistic regression model. ResultsThere were 109 patients from 91 studies identified in this analysis. LT was frequently reported after upper lobectomy (74.4%) and the middle lobe was the most vulnerable lesion (29.4%). The main clinical presentations were dyspnea (38.4%), fever (23.3%), and chest pain (17.4%). Radiologic findings suggestive of LT included worsening consolidation and abrupt truncation/tapering of the pulmonary artery. The overall mortality was 8.3%. Univariate analysis showed that the extent of torsion (whole LT vs lobar torsion) was significantly associated with survival (odds ratio, 5.867; P = .017). No significant difference was found between patients receiving direct resection and those receiving reposition; a trend was observed for worsening outcomes in patients treated with indirect resection (odds ratio, 5.300; P = .060). ConclusionsThe systematic review reveals the prevalence, key diagnostic tests, and optimal treatment methods for lung torsion. Whole LT is associated with higher mortality rates than lobar torsion. If the tortuous part is viable, reposition and direct resection have similar survival rates; otherwise, direct resection should be performed.

Left Lung Torsion: Complication of Lobar Resection for an Early Stage Lung Adenocarcinoma.

Lobar torsion is a fatal but fortunately rare occurrence following lung resection. Early clinical signs and radiographic features may be nonspecific resulting in diagnostic delay. A high index of suspicion is vital for early diagnosis and intervention to avoid further parenchymal necrosis and deadly gangrene. We report a case of left lower lobe torsion in a 76-year-old female following elective upper lobectomy for underlying lung adenocarcinoma. Diagnosis was made following highly suggestive radiographic findings prompting bronchoscopy and revision thoracotomy. An emergency detorsion failed to restore lung viability and was followed by completion pneumonectomy. The patient recovered and was discharged on the seventh postoperative day.

Single rotation-gated CT to demonstrate the inferior pulmonary ligaments and the sino-atrial node artery anatomy

Purpose The inferior pulmonary ligaments (IPLs) and sino-atrial node artery (SANA) are thoracic structures difficult to image. Little has been published concerning frequency, size, origin and direction. The SANA course, origin and distribution are important, with increased frequency of trans-atrial septal intervention. The IPL may be important in lung collapse, consolidation, fluid collections and torsion. Methods and materials The study included 100 consecutive cases of cardiac computed tomography (CT). For SANA, the vessel of origin and unusual anomalies were recorded. For left IPL (LIPL), length of the double pleural layer and presence/length rarer right IPL was documented. Anomalies and unusual shapes were recorded and whether the ligaments reached the hilum. Results The SANA visualised 99 subjects: 66 from the right coronary artery 22 circumflex 9 patients dual supplies, right coronary artery (RCA) and circumflex. 2 exclusive supply branch directly from the aorta. Eleven patients origin at the distal circumflex. IPL seen 88% cases: 31 both left and right IPLs. 1 had only a right-sided ligament. Average corrected length LIPL: 55.1 millimetres (mm), right IPL (RIPL): 14.6 mm. Fourteen LIPLs traceable to the hilum. Previous CT studies suggested a double structure, this gated study showed no cases where the structure was visualised as two layers. Conclusion We have documented the in-depth features on high-resolution Electrocardiogram (ECG) gated scanning using a unique single-rotation system acquiring 160 mm of x-axis data in 1/3 second. We believe changes documented in our study are due to the ultra-high resolution technique.

Left common basal pyramid torsion following left upper lobectomy/segmentectomy

Lobar or segmental lung torsion is a severe complication of lung resection. To the best of our knowledge, common basal pyramid torsion has never been reported. We describe a case of left basal pyramid torsion after left upper lobectomy and superior segmentectomy, which was successfully treated by thoracoscopic surgery.

Lung torsion after tracheoesophageal fistula repair in an infant

Lung torsion is a very rare event that has been reported in only 9 cases in the pediatric literature but has not yet been reported in Korean infants. We present a case of lung torsion after tracheoesophageal fistula repair in an infant. Bloody secretion from the endotracheal tube and chest radiographs and computed tomographic scan results indicated lung torsion. Emergency exploration indicated 180° torsion of the right upper lobe (RUL) and right middle lobe (RML). After detorsion of both lobes, some improvement in the RUL color was observed, but the color change in the RML could not be determined. Although viability of the RML could not be proven, pexy was performed for both the lobes. Despite reoperation, clinical signs and symptoms did not improve. The bronchoscopy revealed a patent airway in the RUL but not in the RML. Finally, the RML was surgically removed. The patient was discharged on the 42nd day after birth.

Recurrent Lobar Torsion

We report a first case of 180° left upper lobe lung torsion followed by a 90° lobar torsion in the same lobe after a left lower lobectomy.

Left cranial lung torsion in a Bernese Mountain dog: a case report

Lung lobe torsion (LLT) is an uncommon pathology in small animal practice. In large breed dogs LLT effects are localized mainly to the middle lobe of the right lung. This report describes a case of left cranial lung torsion in a Bernese Mountain dog: the patient was referred with a two-day history of asthenia, anorexia, dyspnea and haemoptysis. No trauma was reported. Physical examination showed the presence of bilateral pleural effusion confirmed by radiography and ultrasonography. Broncoscopy revealed that the left cranial lobe appeared to be compressed laterally with complete occlusion of the lumen. Thoracoscopy was performed to exclude other pathologies of the pleural space. The pathological lobe was removed. Histological examination revealed aspects consistent with lung lobe torsion. Clinical follow up carried out after three months showed a normal clinical course.

Lobar Torsion after Video-Assisted Thoracoscopic Lobectomy: 2 Case Reports

Lung torsion is a rare but potentially lethal complication after pulmonary resection. We report two cases of right middle lobar torsion after video-assisted thoracoscopic (VATS) right upper lobectomy in our unit. The two cases were diagnosed definitely 7 and 14 days after VATS surgery by computed tomography (CT) scan and bronchoscopy, respectively. Rethoracotomy and right middle lobectomy were performed in both patients. VATS lobectomy contributes to the development of lobar torsion so this complication should be considered. Carefully checking anatomical structures before thoracotomic closure and correctly suturing the middle lobe to the consecutive lobe are effective ways to prevent this complication.

Bilateral Whole-lung Torsion After Bilateral Lung Transplantation

A 61-year-old man with severe idiopathic pulmonary fibrosis developed subacute, bilateral lung torsion after uneventful double lung transplantation. Unenhanced chest computed tomography demonstrated abnormal orientations of both lung allografts with narrowing of the main and lobar bronchi. Surgical reexploration confirmed clockwise rotation of the left lung allograft and counterclockwise rotation of the right lung allograft around their respective hilar axes, as viewed from the ipsilateral axilla. Our case illustrates the value of computed tomography imaging in identifying abnormal lung orientation and bronchial narrowing, and we discuss the potential mechanism for this unusual postoperative event.

Simple Prophylactic Fixation for Lung Torsion

Although pulmonary torsion is a rare complication after lung resection, thoracic surgeons should always consider the risk of this development. We describe a new prophylactic method to repair the residual lobe by using an absorptive sheet and fibrin glue. Between January 2009 and March 2010, 6 patients underwent this simple prophylactic fixation for lung torsion, and their clinical records were retrospectively reviewed. No postoperative complications were observed in this series. This technique is satisfactorily effective and does not result in any complications.

Cardiac herniation and lung torsion following heart and lung transplantation

A 45-year-old male heart-lung transplant recipient reported reduced exercise tolerance two months post-transplant. Spirometry, right heart pressures, bronchoscopy, trans-bronchial and endomyocardial biopsy were normal. Investigations demonstrated posterior and leftwards herniation of the heart through the posterior pericardial window created during the transplant operation with secondary 90 degrees forward twist of the left lung. This phenomenon generated mild functional narrowing of the left pulmonary artery demonstrable on magnetic resonance imaging. Cardiac herniation with lung torsion is a rare finding post heart-lung transplantation and usually manifests in the early postoperative period with haemodynamic compromise, requiring immediate correction. Our case demonstrates that heart graft herniation and secondary partial lung torsion can occur in the chronic phase without catastrophic consequences.

Complete Lobar Torsion Simulating Hemorrhagic Shock after Left Upper Lobectomy

Lung torsion is a rare but serious complication after thoracic operations. We describe an unusual case of left lobar torsion after video-assisted thoracoscopic upper lobectomy. The profound symptom was impending hemorrhagic shock, which masqueraded as postoperative bleeding. The differentials between these 2 entities and treatment options for lung torsion are discussed.

Lung torsion after tracheoesophageal fistula repair: a case report and review of literature

Lung torsion is a very rare event that has been described after trauma, spontaneously, and post–thoracic surgery, with only 8 cases reported in the pediatric literature. We present the first case report of lung torsion complicating tracheoesophageal fistula repair. The diagnosis was suggested on chest ultrasonogram and Doppler and confirmed by computed tomographic scans. On exploration, a 90° rotation of the right middle and lower lobes in a clockwise direction was found. A complete interlobar fissure and an absent inferior pulmonary ligament were identified as predisposing factors. The lobes were untwisted, and lobar fixation was performed to prevent retorsion. Postoperatively, the patient recovered complete lung function, and the patient's chest radiologic and ultrasonographic examination results normalized. Lung torsion is an extremely uncommon event. It causes clinical deterioration in the face of normal arterial blood gases and requires a high index of suspicion for diagnosis. Resection of the twisted lung or lobe may be unnecessary if diagnosis is made early and vascular occlusion is partial. Patients with complete interlobar fissures may benefit from pulmonary lobe fixation as a prophylaxis against occurrence or recurrence of this complication.

Lung Torsion Associated With Complete Bronchial Transection After Blunt Chest Trauma

Lung Torsion Associated With Complete Bronchial Transection After Blunt Chest Trauma

Cardiothoracic Surgery after Heart and Heart-Lung Transplantation

We sought to examine our management and the outcomes of cardiothoracic procedures after heart and heart lung transplantation. We performed a retrospective review of cardiothoracic surgical procedures carried out between 1990 and 2004 in patients who had previously undergone heart or heart-lung transplantation at our institution. Twenty-one out of 340 patients (6.2 %) were identified. Cardiothoracic surgery was performed 44.4 +/- 33 months (range 1 - 115 months) after transplantation. Predominant types of surgery were coronary artery bypass grafting due to allograft vasculopathy (n = 5), aortic surgery due to acute dissection (n = 3), biventricular assist device implantation due to acute rejection (n = 1), tricuspid valve repair (n = 1), multiple cardiac surgical procedures including coronary artery bypass grafting, retransplantation, and tricuspid valve replacement (n = 2), explantation of a functionless heterotopic transplanted heart (n = 1). Lung surgery was performed in six patients due to pneumonia (n = 2), primary lung carcinoma (n = 3), lung torsion following heart-lung transplantation (n = 1). All patients underwent either lobectomy or segmental lung resection. Single lung retransplantation (n = 2) after prior heart-lung transplantation due to bronchiolitis obliterans was performed. In one patient a pneumonectomy (n = 1) due to severe chronic rejection of the contralateral lung was performed. Six subsequent deaths after cardiothoracic procedures were recorded after 1, 4, 78, 163, 205, and 730 days, respectively. Causes of death were advanced carcinoma (n = 1), multi-organ failure due to sepsis (n = 2), sudden heart death (n = 2), and advanced heart failure (n = 1). Fifteen out of 21 patients having undergone cardiothoracic procedures (71.4 %) survived the observation period of 56.6 +/- 34 months (range 1 - 114). Reasons for cardiothoracic procedures after prior heart or heart-lung transplantation were allograft vasculopathy, aortic dissections years after transplantation, chronic rejection, and either lung infections or malignancies. Surgical repair can be performed with an acceptable operative risk and good long-term survival rates.

Postoperative Chest Imaging (Part II): Complications After Major Lung Resection

Abstract This article reviews the postoperative complications following pulmonary resections, which vary according to the type of procedure and the time elapsed since surgery was performed. Early complications include atelectasis, pulmonary edema, pneumonia, bronchopleural fistula, empyema, and less frequent conditions such as cardiac herniation and lung torsion and herniation. Among late complications are postpneumonectomy syndrome, recurrent tumor, and late empyema. The relative low diagnostic accuracy of chest radiography in detecting these complications can be improved with CT, as well as a knowledge of the clinical settings in which specific complications are likely to occur.

Radiographic and CT findings in complications following pulmonary resection.

A variety of pulmonary resection techniques are currently available, including pneumonectomy (intrapleural, extrapleural, intrapericardial, and sleeve pneumonectomy), lobectomy, and limited resection (sleeve lobectomy, segmentectomy, nonanatomic parenchyma-sparing resection). However, pulmonary resection is often followed by postoperative complications that differ according to the type of surgery and the time elapsed since surgery was performed. The most common complications are bleeding, pulmonary edema, atelectasis, pneumonia, persistent air leak, bronchopleural fistula, and empyema. Other, less frequent complications include cardiac herniation, lung torsion, chylothorax, anastomotic dehiscence, wound infection, esophagopleural fistula, and recurrent tumor. The radiologist plays a major role in the diagnosis of various complications following pulmonary resection. Unfortunately, chest radiography has a relatively low diagnostic accuracy in the detection of these complications. When radiographic findings are subtle or equivocal, computed tomography frequently allows more accurate identification of the disease process. Several complications that follow pulmonary resection are life-threatening and require prompt management. Therefore, knowledge of the diverse radiologic appearances of these complications as well as familiarity with the clinical settings in which specific complications are likely to occur are vital for prompt, effective treatment.

Lung Torsion After Lung Transplantation

Lung Torsion After Lung TransplantationEvaluation with Helical CTR. C. Gilkeson1, Paul Lange2 and Thomas J. Kirby3Audio Available | Share

Lung Torsion

In a patient with lung torsion, computed tomography demonstrated an occluded right upper lobe bronchus with opacified posterior lung. A pulmonary angiogram demonstrated the right upper lobe artery to be posteriorly and inferiorly displaced into the consolidated lung. In selected cases, computed tomography and angiography can help to confirm a torsed lung.

Acute, life-threatening complications of lung transplantation.

Acute, life-threatening complications of lung transplantation are common in all reported series. The clinical courses and images of 70 patients who underwent heart-lung (n = 5), bilateral sequential lung (n = 31), or single-lung (n = 38) transplantation were retrospectively reviewed. Sixty-five acute, life-threatening complications occurred in 26 patients (37%) within 3 months after transplantation. Nine deaths occurred as a result of these complications for a mortality rate due to acute complications of 13%. The deaths were a result of bleeding (n = 4), sepsis (n = 2), severe acute rejection and adult respiratory distress syndrome (n = 1), multiorgan failure (n = 1), and diffuse alveolar damage and respiratory failure (n = 1), a distribution of causes similar to those in other reported series. Specific diagnoses that can be made with imaging include hemothorax, lung torsion, pneumomediastinum, pulmonary embolism, pneumothorax, bronchial anastomotic dehiscence, lung collapse, paralysis of the diaphragm, and sternal dehiscence.